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MEDICINA E CHIRURGIA DELLA CAVIGLIA E DEL PIEDE

A Journal on Physiopathology and Surgery of the Foot


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Chirurgia Del Piede 2000 March;24(1):11-6

language: English

Surgical management of metatarsalgia caused by MTP. Joint destruction in Freiberg's disease

Kuhn H., Küster H.-H., Beckmann A.


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Background. Freiberg-Koehler's disease is a rare aseptic necrosis of the head of the metatarsal bone. Metatarsalgia as the patients initial complaint should release a further clinical and radiological investigation. The success of surgery depends on a pre- and intraoperative staging and an appropriate surgical procedure.
Methods. The postsurgical results were evaluated retrospectively after an average follow-up duration of 25 months. We treated 21 patients with an average age of 53 years. In 67% associated forefoot disorders were observed in relation with Freiberg-Koehler's disease. 23 metatarsal heads showed typical clinical signs and radiological osteonecroses. All involved metatarsophalangeal joints were treated surgically. Soft tissue procedures, curretage and bone grafting were used for joint remodelling in cases without major joint destruction. Different osteotomies, resection of the necrotic zone or arthrodesis were indicated in cases with an incongruent articular surface. In 13 cases operations on other parts of the forefoot were performed furthermore. The newly created postoperativly employed forefoot score contained subjective judgements and objective clinical findings.
Results. 49% of the patients had an excellent and 38% a good result in the total evaluation, a fair result was established in 13% and no failure.
Conclusions. The evaluation permits to propose a stepwise surgical approach to treat the different stages of the metatarsophalangeal joint destruction in Freiberg-Koehler's disease and to produce a stable joint.

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